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HQP-PFF-123 Request for Loyalty Card Enrollment Kiosk
Pag-Ibig request enrollment form for loyalty card - kiosk
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: HQP-PFF-123
(V02, 01/2018)
Request for Loyalty Card Enrollment Kiosk
(V01, 07/2017)
Month
Loyalty Card Enrollment Kiosk.
Date/s
______
.
to
, 20
.
______
Yes! Please provide our office a
.
to
, 20
.
Check the month and indicate your preffered date.
Employer/Business Name
No. of Employees
Employer/Business Address (Please indicate complete address)
Authorized Representative/Contact Person
Telephone Number
Email Address
Requested by:
___________________________________________
Head of Office/Authorized Representative
Signature over Printed Name
______________________________
Designation/Position
__________________________
Date
Agreement
This office agrees to collect the corresponding Loyalty Card Fee of its employees, applying for the Loyalty Card through the
Enrollment Kiosk to be deployed at our office on the above-stated date/s, and remit said amount to Pag-IBIG Fund, on or before
the scheduled date as reflected in the notice that this office shall receive for the purpose.
Certified by:
___________________________________________
Head of Office/Authorized Representative
Signature over Printed Name
______________________________
Designation/Position
__________________________
Date
For Pag-IBIG Fund Use Only
Kiosk Deployment Approved by
No. of Kiosk for Deployment
Minumum No. of Confirmed Applicants
HQP-PFF-123
(V02, 09/2017)
Request for Loyalty Card Enrollment Kiosk
(V01, 07/2017)
Month
Loyalty Card Enrollment Kiosk.
Date/s
______
.
to
, 20
.
______
Yes! Please provide our office a
.
to
, 20
.
Check the month and indicate your preffered date.
Employer/Business Name
No. of Employees
Employer/Business Address (Please indicate complete address)
Authorized Representative/Contact Person
Telephone Number
Email Address
Requested by:
___________________________________________
Head of Office/Authorized Representative
Signature over Printed Name
______________________________
Designation/Position
__________________________
Date
Agreement
This office agrees to collect the corresponding Loyalty Card Fee of its employees, applying for the Loyalty Card through the
Enrollment Kiosk to be deployed at our office on the above-stated date/s, and remit said amount to Pag-IBIG Fund, on or before
the scheduled date as reflected in the notice that this office shall receive for the purpose.
Certified by:
___________________________________________
Head of Office/Authorized Representative
Signature over Printed Name
______________________________
Designation/Position
__________________________
Date
For Pag-IBIG Fund Use Only
Kiosk Deployment Approved by
No. of Kiosk for Deployment
Minumum No. of Confirmed Applicants
